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Session: Vaccination
Room: Meeting Rooms 25+26
Time: Fri 08:30-09:45

Presenter: Anna Lugnér (RIVM. CIb)

Abstract

For several years, there has been concern about the impact on society and public health of a pandemic influenza outbreak. The impact has been predicted using dynamic, mathematical models, mimicking the spread of the influenza virus within a population. These transmission models have been based on different assumptions regarding the severity of disease and the likelihood that the total population would lack immunity against a new virus.
The aim of our study is to investigate the cost-effectiveness of different vaccination policies in three European countries using a dynamic modelling approach.
We used a dynamic model of influenza transmission parameterized using data and assumptions of influenza pandemics during the 20th century. Since the outbreak of the novel influenza A(H1N1) additional information about an influenza pandemic has become available. We added this new information and compared the model parameterized under the assumptions that were made before the pandemic, with the model parameterized with information from observations of the current pandemic for several scenarios. The prominent new information added was the apparent existent pre-immunity against the novel A(H1N1) virus among the elderly population.
If there is a limited amount of an effective vaccine, choices have to be made regarding which groups in the society to vaccinate. Furthermore, if an effective vaccine is available before an outbreak the spread of the virus could be effectively contained. If a vaccine is available around the peak of the pandemic a different approach is warranted to avert complications of the illness. The effect of these issues on the cost-effectiveness of vaccination has not been extensively investigated yet. Therefore, we defined four strategies in different scenarios (before or at the peak of the pandemic) for vaccination: vaccinating the whole of the population, half of it, only elderly or only schoolchildren and teenagers. With the model we investigated the impact on the transmission of the virus and the cost-effectiveness of different vaccination strategies for Germany, The Netherlands and the UK. Since the spread of infectious diseases relies heavily on contacts between infected and susceptible individuals, differences in contact patterns influence the spread in different countries. For this reason, next to country-specific costs, country-specific contract matrices and population demographics were applied in the analyses.
Results reveal that cost-effectiveness ratios are less influenced by adding newer data on existing pre-immunity among the population than what might have been expected. Interestingly, even if these countries have different population structures, with Germany showing a relatively higher proportion of elderly, the general results are similar for all three specific settings.

Key Terms

dynamic modeling, pandemic influenza, vaccination, policy, cost-effectiveness

Authors:

Anna Lugnér (RIVM. CIb) , Michiel van Boven (RIVM. CIb) , Robin de Vries (University of Groningen) , Jacco Wallinga (RIVM. CIb) and Maarten Postma (University of Groningen)

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